Dr Héctor Javier Sánchez specializes in public health and research methodology and holds a master’s degree in epidemiology. He is a senior researcher in the Society, Culture and Health Department at El Colegio de la Frontera Sur, Mexico. The Colegio is a public research institution concentrating on environmental, economic and social issues related to a […]
Coordinator, National Pediatric Cardiology Network William Soler Children’s Heart Center, Havana “Our family wasn’t rich, but we didn’t want for anything,” says Dr Palenzuela by way of introduction. In 1950s Cuba, her father drove a taxi and her mother was a homemaker, raising two daughters—one now an economist and the other a top pediatric cardiologist. […]
She was a country girl from the northeastern Cuban province of Holguín, her father a farmer, her mother a teacher. Fast forward a few decades: Dr Lilliam Álvarez mastered mathematics, physics and nuclear science, finally specializing in numeric solutions to differential equations. She spent 20 years at the Cybernetics and Physics Institute in Havana, half that time as deputy director. For another eight years, she served as director of science in the Ministry of Science, Technology and the Environment. Full professor and senior researcher at the University of Havana, she is a member of the national academic authority that awards doctoral degrees in math and is Cuba´s ambassador to the International Mathematical Union. In 2000, she was inducted into the Caribbean Academy of Sciences, and in 2008, was elected a full member of the Third World Academy of Science (now The World Academy of Sciences).
But over time, her rich bibliography, with titles the likes of A numerical technique to solve linear and non-linear singularly perturbed problems began to be peppered with other provocative gender-informed work: Women doing hard sciences in the Caribbean, Are Women Good for Math? and her 2011 book Ser mujer científica o morir en el intento (Be a Woman Scientist or Die Trying). Her focus on women in science—and their rights to belong in its leadership as well as its ranks—is also reflected in her activist approach internationally and in Cuba.
She is a member of the Organization for Women in Science for the Developing World and heads its Cuban chapter. After her designation as a Distinguished Member of the Cuban Academy of Sciences, she was elected Secretary in 2010 and also chairs its Commission on Women in Science.
The Cuban Academy of Sciences was the right place to hear her story and to explore the way she sees women scientists in today’s Cuba—and the country she would like to see in the future.
How does a developing island nation, beleaguered by climatic challenges and 60 years of adverse geo-political pressures become a beacon of scientific innovation, medical services and applied research—all on a shoestring budget? What’s more, how does such a country, rooted in a traditional patriarchal paradigm, overcome barriers to create a scientific and medical community where the majority of researchers and professionals are women? These are some of the questions that motivated MEDICC Review to publish this series on Cuba’s women in STEM (science, technology and math).
Spanning a variety of themes and disciplines exploring the history of women and science; the role of female protagonists in the development of Cuba’s public health and biopharmaceutical sectors; and results produced by women professionals and their colleagues, these interviews illuminate lessons learned and what strategies might be applicable, adapted and replicable in other contexts. This time, we explore the intersection of gender and race in Cuba, a country with the world’s third-highest percentage of female parliamentarians—many of them women of color.
To help us better understand this complex topic, we spoke with Dr Lourdes Serrano, who served as Director of the Cuban Anthropology Institute* (under the aegis of the Ministry of Science, Technology and the Environment and the Cuban Academy of Sciences) from 1991 to 2005.
During her tenure there, Dr Serrano’s research focused almost exclusively on gender and race, including the impact of structural and policy changes since 1959; the manifestations of discrimination and bias in contemporary Cuba; and the role of women in economic, cultural and political life. A lifelong scholar and teacher, Dr Serrano is currently professor at the University of Havana in the Cuban History and Caribbean Studies Departments, and also a coordinator of the Afro-Descendant Caribbean Women’s program in the University’s Caribbean Studies Department.
A 2014 PAHO resolution that Cristian Morales helped formulate serves as a framework for the Americas’ governments to actively work towards health for all their people, incorporating this aim into national programs for sustainable development. This September, the UN General Assembly will sponsor a High-Level Meeting on Universal Health . . . a first in its history. In part two of MEDICC Review’s interview with Dr Morales, he outlines strategies he believes vital for transforming health systems to reach universal health—defined as coverage and access for all—and for turning words into action.
Throughout the 1980s, Cuban researchers at the country’s biotech campus known as the Scientific Pole were making innovative discoveries and began developing unique therapies and vaccines unavailable elsewhere in the world. The pace and level of innovation meant prioritizing the establishment of a dedicated, internationally-certified institute for clinical trials. These and other accomplishments in science and related sectors, coupled with statistics revealing that 53% of all scientists in Cuba are women, prompted MEDICC Review to publish a series of interviews with outstanding Cuban women in science, technology and medicine.
In this, the second installment in the series, we spoke with Dr María Amparo Pascual, a biostatistician, researcher and professor, and the driving force behind the design and establishment of Cuba’s Clinical Trials Coordinating Center (CENCEC). From 1991 to 2014, Dr Pascual served as founding director of CENCEC. During that time the center implemented internationally-recognized good clinical practices (GCP), launched the National Clinical Trials Coordinating Network to support trials overseen by CENCEC, began conferring master´s and doctoral degrees in clinical trials; initiated a quality management system for all trials (receiving ISO 9001 certification in 2008) and created the Cuban Public Registry of Clinical Trials—a bilingual, WHO–accredited Primary Registry, the first in the Americas. In 2013, the BBC recognized Dr Pascual as one of the most influential female scientists in Latin America for her achievements, including becoming Cuba’s first biostatistician and her work at CENCEC.
He was born in Chicago, Illinois, USA, but his family is Cuban. After 1959, they returned to the island, where Dr Mitchell Valdés received his medical degree at the University of Havana in 1972. He went on to study clinical neurophysiology, earning his PhD with a dissertation on the auditory system’s sensory physiology. When the Neuroscience Center opened (as part of western Havana’s Scientific Pole). he became its director, a post he holds today. Dr Valdés, a Distinguished Member of the Cuban Academy of Sciences, is widely published and has collaborated with colleagues in dozens of countries, including the USA, UK, Italy and Holland. He is a full professor of clinical neurophysiology, sits on Cuba’s National Coordinating Group for Persons with Disabilities, and serves as an honorary professor at the University of Illinois at Chicago. What brought me to his office is the set of symptoms reported by some two dozen US diplomats in Cuba and more recently in China as well. And the controversy surrounding what might be the root cause—a topic that has crossed the line from medicine into politics. MEDICC Review’s intent was to hear from Dr Valdés on the science pertinent to the controversy.
Cristian Morales, an economist by training, has dedicated his career to improving health and health equity in the Americas through his work with PAHO/WHO. This has taken him from floods and earthquakes in Haiti to PAHO’s Washington DC offices, where he was instrumental in achieving consensus on a resolution aiming for universal health—coverage plus access—approved by all governments in the Americas. Since 2015, he has served as PAHO/WHO Permanent Representative in Cuba and has recently been appointed to the analogous post in Mexico. At the end of his three years in Havana, MEDICC Review talked with Dr Morales about his experience, the Cuban health system, and the values it shares with the organization he represents. This is part one of the interview, the second part to be published in our January 2019 issue, in which we’ll talk more about the health system in Cuba itself, its achievements and also its challenges.
After nearly 60 years of universal education and health, coupled with national policies supporting women’s rights and advancement, the results are in: according to recent data, more than half of Cuban scientists and almost 60% of all professionals in Cuba are women. Moreover, women’s representation in government is rising, including at the highest levels such as parliament, where they constitute 53.2% of members. Digging deeper, we find a story richer than national statistics or political representation. It’s the story of the collective achievements of female professionals on the island. For example, the clinical research team responsible for developing CIMAvax-EGF, Cuba’s novel biotech therapy for non-small cell lung cancer, was headed by a woman. Likewise, the lead scientist of the Cuban team that developed the world’s first effective meningitis B vaccine is a woman. And the cofounder of the country’s clinical trials coordinating center and registry is a woman, as is the founder of the National Center for Agricultural Animal Health. Yet, as in any country, there is more to be done to achieve true gender parity and release the full potential of women. To begin our series profiling outstanding Cuban women professionals, MEDICC Review spoke with sociologist Dr Marta Núñez, who has devoted decades to research on gender relations and the role of women in Cuba. She provides an overview and framework for contextualizing the advancement of Cuban women—including the challenges still to overcome.
Full disclosure: chief weather forecaster is not his official title, but rather one affectionally conferred on Dr Rubiera by the Cuban people, who look to him not only in times of peril, but also to learn about the science of meteorology. Anyone who has taken a taxi in Cuba during hurricane season (June 1 to November 30), and bothered to ask the driver, will receive a clear explanation about how hurricanes are formed, what the Saffir-Simpson scale is all about, and how the season is shaping up—all courtesy of Dr Rubiera’s talent for communication during nightly weather forecasts and special broadcasts. It’s no exaggeration to say that he is something of an icon in Cuba, a man people trust.
Now, he is retired as chief of forecasting at Cuba’s Meteorology Institute, but he stays on as an advisor, and since 1989 represents Cuba’s Meteorological Service as the Vice Chairperson of the World Meteorological Organization’s Hurricane Committee for Region IV (North America, Central America and the Caribbean). He also keeps a spot on nightly news and hosts two TV shows of his own: Global Weather and Weather in the Caribbean. And his PhD in meteorology serves him well as full professor at the University of Havana in—what else?—meteorology communications.
Finally, he has been a driving force in Cuba for collaboration with Miami’s National Hurricane Center (NHC) and other US meteorologists (in fact, the Chairperson of the Region IV Committee is the head of the NHC).
But, as he says over a cup of rich Cuban coffee, it all started with a two-year-old in a yellow sweater.
Mientras recorría las nieves del Himalaya para atender pacientes después del te-rremoto de Pakistán en 2005, el internista Félix Báez nunca podría haber imaginado que nueve años más tarde estaría en la primera línea del enfrentamiento al ébola en Sierra Leona… y mucho menos, que contraería el mortal virus, sobreviviría para contarlo y además, que regresaría con sus colegas a África para continuar la batalla. A su lado, en el Hospital Universitario de Ginebra a donde fue transportado por vía aérea, estuvo el Dr. Jorge Pérez, hoy director del Instituto de Medicina Tropical Pedro Kouri (IPK) de Cuba, pero más conocido como “el doctor cubano del sida”. Para ambos médicos los tiempos han cambiado, y ahora, cuando el ébola hace estragos, es lo primero en sus mentes,
Al momento de esta entrevista, aunque existe un optimismo cauteloso en Liberia, la epidemia no está aún bajo control. El ébola ha infectado cerca de 22 000 personas, llevándose consigo más de 8 600 vidas; Sierra Leona es uno de los países más golpeados. Entre los contagiados y las víctimas mortales ha habido muchos trabajadores locales de la salud: 103 de los 138 infectados según la última cuenta.
El primero en lanzar la alarma global fue Médicos sin Fronteras, quienes, como Cuba, ya tenían personal médico en tierras africanas. A estos se unieron muchos otros, y Cuba fue el país que ofreció la mayor ayuda una vez que la OMS hizo el llamado a las naciones para hacer frente a la epidemia con financiamiento y, más importante aún, con recursos humanos.
Cuba envió 256 voluntarios, todos con una sólida experiencia en emergencias internacionales: 38 a Guinea, 53 a Liberia y 165 a Sierra Leona. Y otros esperan a tomar el relevo, todos trabajadores de la salud entrenados en desastres y que han recibido ya un primer curso sobre ébola en el IPK.
Estos cubanos y otros voluntarios internacionales están logrando salvar a pacientes de una muerte segura, apoyando a los trabajadores de la salud y los educadores comunitarios locales. Y personas como Jorge Pérez están trabajando a fondo en la investigación del ébola para ayudar a evitar su diseminación por toda África y otras zonas del mundo.
Pero evitar que otra epidemia así tenga lugar nuevamente, requiere más, mucho más. No solo la comunidad internacional pudo haber hecho más esta vez. Sino que, como advirtió Jim Kim, Presidente del Banco Mundial, el ébola no empezó con la enfermedad, sino más bien con las desigualdades históricas, enconándose el virus en sistemas de salud que apenas logran funcionar. Una lección para todos nosotros.
Horas antes de que el doctor Báez regresara a Sierra Leona —donde se encuentra actualmente— MEDICC Review lo entrevistó a él y al Dr. Pérez en el IPK, en la Habana.
Cuba’s nascent biotechnology sector began making scientific breakthroughs in the 1980s, including the isolation of human leukocyte interferon alpha (1981) and the development of the world’s first safe, effective meningitis BC vaccine (1989). With positive results in hand and a growing R&D pipeline, the island nation established a national regulatory authority (NRA) to implement and oversee best practices for all pharmaceuticals and medical devices, domestically produced and imported, used in the country’s universal health system. Founded in 1989, Cuba’s Center for State Control of Medicines and Medical Devices (CECMED) is the entity charged with regulating all phases of scientific innovation for health, from clinical trial design to postmarketing surveillance.
Dr Rafael Pérez Cristiá, Distinguished Member of the Cuban Academy of Sciences, has been Director General of CECMED since 2000, overseeing regulation and control of unique and innovative biotechnology products and the concomitant evolution of the nation’s regulatory authority. Under his guidance, CECMED has regulated unique therapies, vaccines, and pharmaceutical products—some unavailable anywhere else in the world—aimed at improving population health both at home and abroad. Recognized internationally as one of the top 20 countries with a safe and reliable biotechnology industry and regulatory authority, Cuba is having a measurable impact on public health. In this exclusive interview, Dr Pérez Cristiá, explains how a small, resource-scarce country has rocketed into the global biotech elite—and how it intends to stay there.
Her passion for the “new world of informatics” led engineer Niurka Carlos to study computer sciences and digital systems, and her passion for health led her to join the embryo of Cuba’s Immunoassay Center in 1982 right after graduation from university in 1987, becoming one of the Center’s founders when it was launched that same year. First specializing in software, Ms Carlos was promoted to department chief, the Center’s management team and later to deputy director. She has headed the Center since 2014, leading implementation of research, production and marketing of diagnostic tools for the national health system and export. Today, the Center is expanding its horizons into chronic diseases that have become the main causes of illness and death in Cuba and are afflicting low- and middle-income countries at alarming rates as part of the world’s epidemiological transition. MEDICC Review spoke with Ms Carlos about the history, results, challenges and new frontiers of the Center in its 30th anniversary year.
Soon after the Molecular Immunology Center (CIM) was established in 1994 (a founding institution of Havana’s biotechnology and pharmaceutical campus known as the scientific pole), Dr Crombet completed her master’s thesis there. She joined CIM’s team in 1998 and in 2004 was designated Director of Clinical Research. She has participated in the research, development and clinical trials of some of Cuba’s most innovative therapies and vaccines, including CIMAvax-EGF for non-small cell lung cancer patients. In 2015, this therapy completed Phase IV clinical trials in Cuba and is now used in primary health care services throughout the country’s national health system. CIM and Roswell Park Cancer Institute (Buffalo, New York) received US Department of Treasury approval in 2015 to test CIMAvax-EGF and other CIM products in the United States, opening the way for the Food and Drug Administration (FDA) to consider joint ground-breaking Phase I and II clinical trials in the USA. Recent regulatory changes introduced by President Barack Obama may make applying for such licenses a thing of the past—at least that is what researchers hope.
In any case, the work of Dr Crombet and the teams at CIM is making headway in cancer immunotherapy, within the broader goals of the institution’s mandate…the subject of our interview.
After leaving Chile during the Pinochet era, Dr Morales studied economics, health administration and international health at the University of Montreal. But his baptism in the field came in Haiti, where he was first PAHO advisor to the health ministry, and then for five years was responsible for human resources and health economics in the PAHO offices in the capital of Port-au-Prince. He was at his post during the flooding in Gonaïves, five hurricanes, the 2010 earthquake and the ensuing cholera epidemic—doubtless the most dramatic and complex times for the country’s health in recent history. Before becoming the PAHO/WHO Representative in Cuba in 2015, he was Regional Advisor in Financing and Health Economics based in Washington, DC. In that role, he plunged into the often thorny debates about just how far governments of the Americas were willing to go towards achieving universal health—universal coverage plus universal access. The result was a historic resolution passed in late 2014 by PAHO’s Directing Council (CD53.R14 Strategy for Universal Access to Health and Universal Health Coverage). Dr Morales talks about the process, the outcomes… and the road ahead.
Llámeles intrépidos pioneros o simplemente tenaces: más de 200 estudiantes de Estados Unidos, principalmente de minorías marginadas y de familias de bajos ingresos, decidieron que se convertirían en los médicos que necesitan sus comunidades, y que sería la Escuela Latinoamericana de Medicina de Cuba (ELAM) la que los prepararía para el trabajo.
Al hacerlo, aceptaron una multitud de desafíos, entre ellos el de estudiar en un país elogiado por sus indicadores de salud poblacional, pero vilipendiado durante décadas por su gobierno. Bajo el presidente George W. Bush, la inscripción en la escuela requería incluso la intervención del entonces Secretario de Estado Colin Powell y del Caucus Negro del Congreso, cuyos miembros representan distritos con algunos de los peores indicadores de salud de los Estados Unidos. Una vez aceptados por la ELAM, que tiene sus propios requisitos académicos altos, no estaba claro si podrían afrontar la vida en Cuba, un país pobre con recursos limitados. Y luego viene el reto de aprobar el Examen de Licencia Médica de Estados Unidos (US Medical Licensing Examination, USMLE), que se exige a todos los estudiantes de medicina de Estados Unidos para obtener plazas en los programas de residencia.
Además de estos obstáculos había otra gran interrogante: ¿trabajarían realmente en comunidades remotas, en distritos urbanos de bajos recursos y pobres o simplemente aprovecharían la educación médica gratuita y abandonarían los objetivos sociales inculcados por su alma mater?
El concepto de la ELAM es simple, pero audaz: brindarle educación médica gratuita a estudiantes brillantes dispuestos a convertirse en médicos, pero que carecen de los medios económicos para ello, los motivará al regresar a servir en comunidades como las propias. Ellos pasan seis años estudiando ciencias básicas, medicina clínica y salud pública. A partir de la primera graduación en el 2005, la ELAM ha capacitado cerca de 25 000 médicos —la mayoría mujeres y muchos de ellos indígenas— de 84 países, incluido Estados Unidos.
Una década después de que el primer graduado de Estados Unidos recibió su diploma de la ELAM, otros 113 se han graduado. Mientras que la mayoría de los graduados (especialmente los recientes) están aún terminando sus exámenes de USMLE, el 40% de ellos ya está cursando la residencia o la ha completado. De estos, el 90% ha elegido ejercer en tres especialidades principales de atención primaria —medicina familiar (61%), medicina interna (23%) y pediatría (6%). De los graduados estadounidenses que ya ejercen, el 65% trabaja en áreas deficitarias en profesionales de la salud (Health Professional Shortage Areas, HPSA) o áreas médicamente desatendidas (Medically Underserved Areas, MUA). El éxito de estos médicos también ayuda a eliminar el estigma del programa de Cuba; en Estados Unidos, los médicos graduados en el extranjero son a menudo percibidos como menos competentes, ya que se asume que estudian en el extranjero porque no lograron ser aceptados en otro lugar. Pero frecuentemente, como en el caso de los médicos formados en la ELAM, la educación médica de Estados Unidos supone una barrera económica, no intelectual, para su formación.
La Universidad de Ciencias Médicas de La Habana es una de las 14 escuelas de medicina en Cuba. En sus ceremonias de graduación de julio, se entregaron diplomas a más de 1 200 médicos de Cuba, América Central y del Sur, el Caribe, África y Asia —que incluye a los graduados de la ELAM, entre ellos 21 de Estados Unidos.
MEDICC Review entrevistó a varios graduados estadouni-denses de la ELAM mientras se preparaban para regresar a sus hogares —Wyoming, Luisiana, Pennsylvania, Texas, Florida y otros lugares. Hablaron con franqueza sobre las ventajas y los desafíos de estudiar medicina en Cuba, el proceso de concesión de licencias para ejercer en los Estados Unidos, y sus planes para el futuro.
